Concomitant Antiseizure Medication Dose Reduction and Discontinuation After Starting Cenobamate: a Retrospective Review (P4-1.004)

Abstract

<h3>Objective:</h3> This investigator-initiated study examined discontinuations and dose reductions of concomitant ASMs following cenobamate initiation in patients with epilepsy treated at MetroHealth (Cleveland, OH). <h3>Background:</h3> The treatment goal for people with epilepsy who receive polytherapy is seizure control with the lowest possible drug load (lowest numbers and doses). Cenobamate is an antiseizure medication (ASM) approved in the US and EU for uncontrolled focal seizures. <h3>Design/Methods:</h3> Adults with focal epilepsy who started adjunctive cenobamate between 9/2020 and 5/2022 were analyzed by retrospective chart review (target enrollment n=75). Data on concomitant ASMs and doses were collected. <h3>Results:</h3> Eighty-one patients received cenobamate as of 5/2022. Two discontinued because of side effects. Seventy-nine continued on cenobamate as of the data cutoff (mean [range] age, 44.1 [19–74] years; 48% women). Seventy-five started cenobamate because of uncontrolled seizures. Four other patients were seizure-free but started cenobamate to taper off their current ASMs, which were causing intolerable side effects. Among those continuing cenobamate, 34.2% (27/79) discontinued concomitant ASMs, including clobazam (n=15), levetiracetam (n=5), phenytoin (n=3), lacosamide (n=2), lamotrigine (n=1), and oxcarbazepine (n=1). Nine patients achieved cenobamate monotherapy, and 15.2% (12/79) of patients were in the process of tapering off concomitant ASMs, including phenytoin (n=8) and clobazam (n=4). Divalproex sodium dose reductions occurred in 4 patients. At data cutoff, 34.2% (27/79) of patients were seizure-free ≥3 months (range, 3–10 months), including all 4 patients who were seizure-free prior to starting cenobamate and 23 patients with uncontrolled seizures prior to cenobamate. No patients had worsening seizure frequency on cenobamate. <h3>Conclusions:</h3> Initiating cenobamate led to a reduction in concomitant ASM drug load (discontinuation or dose reduction) in 53.1% (43/81) of patients, and some were able to transition to monotherapy. Seizure control was maintained or improved during treatment. These data suggest that cenobamate therapy may allow a reduction or elimination of polytherapy in some patients. <b>Disclosure:</b> Dr. Becker has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Neurelis, Inc. Dr. Becker has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sk life Science. Dr. Becker has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Supernus Pharmaceuticals. Dr. Becker has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Neurelis, Inc. Dr. Becker has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Sk Life Science. Dr. Becker has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Jazz pharmaceuticals. Dr. Becker has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for UBC. Dr. Becker has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for LivaNova. Dr. Becker has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Neuropace. Dr. Becker has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Supernus Pharmaceuticals. Mrs. Demko has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eisai. Mrs. Demko has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for SK Life Sciences. Mrs. Demko has received research support from SK Life Sciences.